Wednesday, April 20, 2011

Gasteroenterology coding:74270 is for barium enema as well as water-soluble contrast


Recently, my gastroenterologist ordered barium enema for a four-year old male patient with a history of encopresis and constipation. Therefore, I am billing the procedure for my radiologist. How should you report the procedure if the radiologist writes the following text in her notes:

Technique: A single frontal scout radiograph of the abdomen was carried out. A rectal tube was inserted in usual sterile fashion, and retrograde instillation of barium contrast was followed through spot fluoroscopic images. A post-evacuation overhead radiograph of the abdomen was carried out.

Findings: The scout radiograph demonstrates a non-obstructive gastrointestinal pattern. There're no suspicious calcifications seen or evidence of gross free intraperitoneal air. The visualized lung bases and osseous structures are within normal limits.

Throughout its course, the rectum and colon is of normal caliber. There's no evidence of obstruction, as contrast is seen to flow without trouble into the right colon and cecum. A small amount of contrast is seen to opacify small bowel loops on the post-evacuation image. There is also opacification of a normal-appearing appendix documented.

Answer: You should report this as a commonly performed barium enema: 74270 (Radiologic examination, colon; contrast [example, barium enema, with or without KUB]).

Medical coding tip: Even though you will normally see barium or barium and air enemas, some doctors may instead choose a water-soluble solution that includes iodine. For instance if the physician suspects perforation of the colon, he will choose a water-soluble contrast solution. For instance, if the physician suspects perforation of the colon, he will choose a water-soluble contrast solution. Do not limit your 74270 coding to barium; you'll use this code for a different kind of contrast agent that your gastroenterologist may use.

That apart, you should bill 99212(Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components:

A problem focused history, A problem focused exam, Straightforward medical decision making(MDE). Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem[s] and the patient's and/or family's requirements. Normally, the presenting problem[s] are self limited or minor. Doctors normally spend 10 minutes in person with the patient and/or family.) to report the evaluation & management service that your gastroenterologist carried out.

For ICD-9, you would have to report the following:


  • 787.6 -- Incontinence of feces
  • 564.00 -- Unspecified constipation.